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Population Health Management in North East London

Population Health Management in North East London

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What is population health?

Population health is about helping everyone in our community to live healthier lives. It means looking at the bigger picture and not just treating illness, but also addressing the things that affect our health, like: 

  • housing 
  • education 
  • income 
  • lifestyle

What is Population Health Management (PHM)?

PHM is a way of using data to plan and improve health and care services. It helps us understand what people need and take early proactive action. 

For example, if data shows that people in one area are more likely to develop diabetes, local services can offer support like: 

  • healthy eating advice 
  • exercise groups 
  • mental health support 

This helps people stay healthier for longer and avoid serious illness.

 

Why PHM matters

PHM helps us: 

  • spot health issues early 
  • offer the right support at the right time 
  • reduce pressure on hospitals and GPs 
  • use public money more effectively 

It also helps us understand the needs of different groups, like older adults, families in poor housing, or people facing language barriers.

What’s changing?

We’re already using PHM in North East London.

Local teams are using data to find people who might be at risk and offer support early. 
We want to make PHM part of everyday work across all organisations. 

Here’s how PHM can make a difference: 

Current situation With PHM
Clinicians only see part of a patient’s journey
We get a full picture of people’s needs
Services react to problems after they happen
We act early to prevent problems
Services are designed around organisations
Services are designed around people
We miss patterns in the data
We use data to plan better services
Staff work individually
Teams work together with shared goals
Frontline teams are under pressure
We reduce duplication and free up time
We don’t always see how care affects different groups
We focus on fairness and reducing inequalities

How PHM works

PHM brings together: 

  • the NHS 
  • local councils 
  • charities 
  • housing services 
  • community groups 

These partners share information and work together to improve health and care for local people. 

PHM helps us: 

  • spot health issues early 
  • offer the right support at the right time 
  • reduce pressure on hospitals and GPs 
  • make better use of public resources 

We use a cycle of improvement to: 

  1. Understand what people need 
  2. Plan services around those needs 
  3. Take action early 
  4. Learn and improve  

What’s next?

We’re building the tools and skills to make PHM work across North East London. 
This includes: 

  • better data and systems 
  • training and support for staff 
  • stronger partnerships between organisations 

As this work grows, you’ll see: 

  • more joined-up services 
  • more community support 
  • more ways to take control of your health 

Whether it’s through your GP, a local health coach, or a community group, PHM is here to help you live a healthier, happier life. 

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